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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 380503937
Report Date: 01/16/2020
Date Signed: 01/16/2020 12:22:32 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:THOMAS, MARY E. & WATSON, JOSEPH SR.FACILITY NUMBER:
380503937
ADMINISTRATOR:THOMAS, M. & WATSON, J.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(415) 239-0213
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94112
CAPACITY:12CENSUS: 6DATE:
01/16/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Mary Thomas, Joseph WatsonTIME COMPLETED:
12:45 PM
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3, Licensing Program Analyst (LPA) Yee conducted an annual random inspection today. There are 6 children, licensee, co-licensee and helper present today. The purpose of the inspection was explained. Residents in the home are Mary and Joseph only. Daycare areas is the same as previously licensed. Day-care: (ground level) only. Garage converted into main day-care areas, bathroom, baby nap room and the backyard. The remaining areas of the house are off limit. The home is equipped with a smoke alarm, carbon monoxide detector and a fully charged fire extinguisher. The facility provides snacks, and lunches. Licensee, co-licensee has current CPR and First Aid until 3/2021. Required immunization for staff is on file. This facility provides Incidental Medical Services - IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children's, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 102417. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/(800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, Available at: http://www.ada.gov/childqanda.htm LPA suggested to have a written IMS plan on file. Children files were reviewed. SIDS information was provided during the visit.

website: www.ccld.ca.gov. Title 22, Div 12, Chp 3
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jennifer YeeTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 01/16/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
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